Pain and clicking in the Right Knee of a Special Olympics Athlete


Q: I play floor hockey 1-2 days after practice I noticed knee pain in my right knee. Took an easy the rest of the week- I was pain free and I practicd again. Again I experienced the same pain. I wasn't totally pain free for the tournement I took part in- was ok to play. When it ended I could hardly walk. My knee started to click when I walk 2 days after the tourney. To make along story short- I went to my doctor the friday after tourney- she took an x-ray, and said it looked good except for a bone spur- but that shouldn't be a problem she said. She said it might be bursitis or a mensicus problem. and sent me to thereapy- 2x a week for 6 wks. I have had almost 6 weeks of Physical thereapy. I am wondering when I will see improvements. I am still having issues going down stairs- it hurts like crazy to go down stairs, its ok going up- but its not the same as it use to be. It is still clicking qutie a bit. Physical thereapist said it would get better as time goes. But I can't avoid stairs.And I have a hard time lifting my leg up to get my sock on, or get dressed. I am still having pain- pain scale 1-10- some days its a 4-5. Tonight its almost a 6 . Therapist said that its common to have set backs. I was on the low end up until 2 weeks ago, pain has been building again. I am wondering at what point I go to an orthopedist, or do I go back to my family doc she said if the therapy didn't help she would do an MRI. I am having pain at night. what can I do to releave it? I have been using an ace bandage, ice, and advil.I cannot go down stairs, kneel- I work with small kids- so kneeling is very important. or lift my leg up to get a sock on or get dressed. I am over weight- but have lost 4 lbs since I started therapy- even tho I have not been active. This is hard for me! I love playing sports. I am a Special Olympics Athlete- I have given up sports until it heals. Any insite would ber great!


A:   The menisci are C-shaped wedges of fibrocartilage located between the tibia and femur, and very close related to knee ligaments and attached also to the joint capsule. They are susceptible to get injured with leg rotation movements or rotational forces applied to them, and the lesion produced can be partial or complete tear. Meniscal injuries are common in young males who are involved in sporting or manual activities. Locking is a common symptom after a meniscal lesion develops. Locking usually occurs at 20-45° of joint extension. If a torn fragment has been trapped within the joint, extension may feel limited against a rubbery resistance.
Joint inflammation or capsular involvement also may resemble locking. A more reliable indicator of meniscal lesion is a click or snaps after the joint unlocks, it can be or not associated with pain. A sensation of giving way may occur when the loose fragment becomes lodged for a moment in the knee joint, causing a sense of buckling. This finding should be distinguished from the sensation of giving way due to joint instability (eg, ACL tear) or buckling secondary to decreased activity of the quadriceps femoris muscle.
Given the description you did about the problem of your knee, and if you had previous history of a knee injury that you can remember, it could be important to rule out a Meniscal lesion. Also might be important to rule out in your case an unbalanced muscle pull that produced excessive pressure or leverage forces on the patellofemoral joint surfaces. The difficulty in flexing the knee along with the grinding feeling that you described are a common presentation of the Patellofemoral Syndrome, which is produced by an impairment affecting the patella and femur joint.
The suggested strategy should be: strengthening and stretching the main muscle of the thigh: quadriceps, to restore the muscle balance around the knee joint, for this is indicated physical therapy for 6 to 8 weeks, using ice packs at the end of the exercise routine to decrease pain and swelling. The use of soft knee braces helps to control patella position and restrict full knee flexion which is good to ease the pain. Also, and very important, the activities or sports that require frequent squatting must be avoided until the pain is under control. If there is a limited response to the treatment, and locking or instability of the affected knee are noticed, then an orthopedic surgeon evaluation must be considered.

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